| Doctor Name: | MARY LOU ACIMOVIC |
| NPI Number: | 1902853898 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.A. |
| License Number: | |
| Business Practice Address: | 3015 47th St Suite E3 Boulder, CO - 803015411 |
| Business Phone Number: | 3034492974 |
| Business Fax Number: | 9702213730 |
| Mailing Address: | Po Box 2086, FORT COLLINS |
| State: | CO |
| Postal Code: | 805222086 |
| Phone Number: | 3034443443 |
| Fax Number: | 9702213730 |
| NPI Enumeration Date: | 05/27/2006 |
| NPI Last Update Date: | 06/11/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |